硬脊膜外腔阻滞复合全身麻醉对髋关节骨折术后认知功能的影响

摘要

目的 探讨硬脊膜外腔阻滞复合全身麻醉在髋关节骨折手术中的应用价值及对患者术后认知功能的影响.方法 选取82髋关节骨折患者为研究对象,行内固定手术或髋关节置换术治疗.以随机数字表法分为对照组41例,观察组41例.对照组采用气管插管全身麻醉,观察组采用硬脊膜外腔阻滞复合气管插管全身麻醉,观察两组患者围术期血流动力学变化、术后认知功能、不良反应发生率.结果 T0、T3时心率(HR)、平均动脉压(MAP)两组比较,差异无统计学意义(P>0.05);T1、T2时观察组HR、MAP与对照组比较,差异有统计学意义(P<0.05);对照组T1、T2时HR、MAP与T0、T3时对比,差异有统计学意义(P<0.05).两组认知功能术后1h时差异无统计学意义(P>0.05).术后4h、8h,观察组蒙特利尔认知评估量表评分较对照组明显较高,乙酰胆碱水平较对照组明显较低,均差异有统计学意义(均P<0.05).术后不良反应发生率观察组为12.20%,同对照组17.07%比较,差异无统计学意义(P>0.05).结论 硬脊膜外腔阻滞复合全身麻醉对术后认知功能影响小.%Objective To explore the application value of epidural anesthesia combined with general anesthesia in the treatment of hip fracture and its effect on postoperative cognitive function.Methods 82 patients with hip fracture were selected as the research object and treated with internal fixation or hip replacement.A random number table was used and divided 41 cases into control group and 41 cases into observation group.The control group was used by tracheal intubation general anesthesia and observation group was with epidural anesthesia and tracheal intubation general anesthe -sia.The hemodynamic changes,postoperative cognitive function,incidence of adverse reactions and vasoactive drug dos-age were observed in the two groups.Results At T0and T3,there was no significant difference between the two groups in HR and MAP(P>0.05).At T1and T2,there was statistically significant difference of MAP and HR between the ob-servation group and control group(P<0.05).In control group,there was statistically significant difference of MAP and HR between T0,T3and T1,T2(P<0.05).There was no significant difference in postoperative cognitive function be-tween the two groups(P>0.05).4 h and 8 h after operation,the MoCA score was significantly higher and Ach level was significantly lower of the observation group than those of the control group,and the differences were statistically signifi-cant(P<0.05).The incidence of adverse reactions in the observation group was 12.20%,compared with 17.07% in the control group,and the difference was not statistically significant(P>0.05).There were no serious adverse reac-tions.There was no significant difference in the dosage of vasoactive drugs between the two groups(P>0.05).Conclu-sion The epidural anesthesia combined with general anesthesia can provide hemodynamic stability,high safety with lit-tle influence for postoperative cognitive function.